1992996615 NPI number — MELISSA L WOLD PT, DPT

Table of content: MELISSA L WOLD PT, DPT (NPI 1992996615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992996615 NPI number — MELISSA L WOLD PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLD
Provider First Name:
MELISSA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BELLINGER
Provider Other First Name:
MELISSA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992996615
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24014 W RENWICK RD UNIT 206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAINFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60544-8711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-974-4378
Provider Business Mailing Address Fax Number:
630-515-1536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1070 N 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMERON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54822-2000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-974-4378
Provider Business Practice Location Address Fax Number:
630-515-1536
Provider Enumeration Date:
08/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  10837 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)